Flaps in Head and Neck Reconstruction
Pramod Kumar2003, Plastic and Reconstructive Surgery
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Abstract
The platysma myocutaneous flap, because of its thinness and pliability, meets preeminently the requirements for reconstruction of defects in the oral cavity. The authors describe their experience in 85 patients with regard to the use of the platysma myocutaneous flap and its complications. The various regions reconstructed were primarily the tongue (47 percent), the buccal mucosa (27 percent), and the floor of the mouth; the remaining flaps were used for the lower alveolus, the lower lip, and the face. None of these patients had received preoperative irradiation, and in none of the patients under study was the flap raised when neck dissection was indicated. The maximum dimensions of the elevated flap were 6 ϫ 10 cm, and rotation of the pedicle was between 90 and 180 degrees depending on the location of the surgical defect. Partial necrosis of the flap was noticed in 17 cases (20 percent), complete flap necrosis was seen in six cases (7 percent), and wound infection was seen in three cases. The authors found the platysma myocutaneous flap to be a useful alternative for lining limited intraoral defects after tumor resection.
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Head and neck reconstruction using the platysma myocutaneous flap
American Journal of Surgery, 1993
A retrospective analysis of our experience with 41 patients who received a platysma myoeutaneous flap for reconstruetion of intraoral and pharyngeal defects is presented. All patients had epidermoid carcinoma of the head and neck region, with tumor size ranging from T1 to T4. The primary sites of malignancy were the oral cavity (61%), the oropharynx (32%), and the hypopharynx (7%). Either radical or modified radical neck dissection requiring routine ligation of the facial artery was performed in all 41 patients. Adjuvant therapy ineluded preoperative or postoperative radiotherapy (39%) and preoperative chemotherapy (73%). The mean hospital stay was 13 days. Flap-related complications occurred in eight patients (19%) only. These included partial flap necrosis involving the epithelium alone, skin necrosis of the neck suture line, and fistula formation. Most complications resolved with local care only. Minor surgical intervention was required in three patients. There were no perioperative deaths. These results indicate that the platysma myocutaneons flap is a viable alternative in head and neck reconstruction.
Platysma myocutaneous flap for oral cavity reconstruction
Ear, nose, & throat journal, 2010
A retrospective study was conducted to assess outcomes of reconstruction of the oral cavity with the platysma myocutaneous flap, in terms of flap survival, complications, and quality of life. Included were 10 patients with squamous cell carcinoma (stage T1 to T4; nodal status N0 to N2) of the oral cavity who were treated between 2002 and 2006. Each patient underwent tumor resection, modified radical neck dissection, and primary reconstruction with a platysma myocutaneous flap. Operating time, length of stay, time to swallow, and complications were assessed, and the University of Washington Quality of Life questionnaire was administered. Mean operating time was <4 hours, mean length of stay was 11 days, and mean time to swallow was 9 days. One patient had distal flap necrosis and one had wound dehiscence. No total flap failures or fistulas occurred. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity. The addi...
The platysma myocutaneous flap (PMF) for head and neck reconstruction: A retrospective and multicentric analysis of 91 T1–T2 patients
Journal of Cranio-Maxillofacial Surgery, 2012
The platysma myocutaneous flap (PMF) was first applied to intraoral reconstructions in 1978. PMF is not only an alternative to microvascular flaps but it also represents an excellent reconstructive choice especially in cases where free tissue transfer cannot be carried out.
Vertical platysma myocutaneous flap reconstruction for oral defects using three different incision designs: experience with 68 cases
International Journal of Oral and Maxillofacial Surgery, 2017
This study evaluated the effects of three different incision designs for the vertical platysma myocutaneous flap (VPMF): apron, MacFee, and T-shaped. This flap was used for the reconstruction of intraoral defects following cancer ablation in selected patients. Sixty-eight cases of VPMF reconstruction were assessed: the apron incision was used in 28, MacFee incision in 22, and T-shaped incision in 18. With regard to postoperative outcomes, there were 26 cases of flap survival and two of partial necrosis with the apron incision; 20 of survival and two of partial necrosis with the MacFee incision; 15 of survival and three of partial necrosis with the Tshaped incision. Success rates were 92.9%, 90.9% and 83.3%, respectively, for VPMF with the apron, MacFee, and T-shaped incisions. A wound healing disturbance in the neck was seen in three cases of VPMF with the apron incision and one case with the MacFee incision. The MacFee incision had the best aesthetic effect, and the postoperative neck scar was more obvious for the T-shaped incision. It is recommended that VPMF with the MacFee or apron incision be used for the reconstruction of larger buccal mucosa and floor of the mouth defects, while VPMF with the T-shaped incision should be used for smaller intraoral defects, especially tongue defects of the lateral surface.
Defect closure after oral and pharyngeal tumor resection with the superiorly pedicled myocutaneous platysma flap: indications, technique, and complications
European Archives of Oto-Rhino-Laryngology, 2012
This study evaluated the myocutaneous platysma flap (MPF) as an alternative to free flaps for closing defects after head and neck tumor resection in selected cases. MPFs were used to close small to medium-sized fullthickness oral and pharyngeal defects after surgery for tumors staged cT1-3 (oral cavity 37.1%, oropharynx 24.3%, hypopharynx 38.6%) in 70 patients. Flap-related complications developed in 27% of cases (partial necrosis 7%, total necrosis 3%, salivary fistula 11.4%, bleeding/hematoma 5.7%) and donor-site complications in 10%. Defect closure was adequate in 97%; 62.5% of the patients required intraoperative tracheotomies (closed again in 72.5%). Postoperative swallowing was not significantly disturbed in 72% of the patients. The MPF allows closure of small to mediumsized defects in the head and neck region in selected patients, with acceptable aesthetic and functional outcomes. The success rate ([90%) is comparable with surgical alternatives associated with considerably greater surgical effort and risk.
A Prospective study on Principles and Outcomes of Reconstructive Flaps in Carcinoma of Cheek
Madridge J Surg, 2018
Background: Cancers of the oral cavity present in a variable way but are often associated with persisting swelling or ulceration within the oral cavity. In the Indian subcontinent, oropharyngeal cancer is the common malignant tumour accounting for 40% of all cancers. Aims and Objectives: To study the principles and outcomes of flaps used in reconstruction of carcinoma of cheek in view of maintaining oral competence, facilitate swallowing, preserving speech, prevent aspiration and to achieve better cosmesis. Materials and Methods: A prospective, open label, randomized, hospital based, single centered study was conducted among 60 subjects attending Surgical Oncology OPD, K.R. Hospital attached to Mysore Medical College And Research Institute, Mysore meeting the inclusion and exclusion criteria over a period of 24 months from January 2016 to December 2017. All patients who present with symptoms and signs of Carcinoma cheek, and confirmed by Edge Biopsy, FNAC of Nodes, X-Ray mandible and ortho pantamogram were included in the study. Patients suffering from Ca lip, Ca tongue, Ca oropharynx and Ca maxilla are excluded. Descriptive statistics, Chi-square test, Multivariate Cox regression analysis were used to analyse the results. Results: The mean age group of the study subjects was 52.63±7.48 (34-86) years. The gender distribution showed 52(86.67%) females as compared to 8(13.33%) males. Maximum number of 29(48.33%) patients presents in Stage-IV while minimum number of 8(13.33%) patients presented in Stage-II. 13(21.67%) and 10(16.67%) patients presented in Stage-III and Stage-I respectively. 15(25%) and 17(28.33%) of patients underwent reconstruction with the Pectoralis major myocutaneous flap(PMMC) & PMMC+DP Flaps respectively. 6(10%) patients underwent tongue flap while 5(8.33%) patients underwent forehead flap (p <0.0001). 4(6.67%) and 1(1.67%) patients underwent Deltopectoral (DP) and tongue +DP flap respectively. Postoperative complications like infection and necrosis occurred in 3(5%) and 1(1.67%) cases respectively, while orocutaneous fistula occurred in 1(1.67%) cases and 1(1.67%) case showed recurrence. Conclusion: Patients subjected to reconstruction of cheek defect with PMMC & PMMC + DP flap shows better results in terms of oral competence, speech, swallowing & cosmetic appearance when compared to other flaps.
The pectoralis major myocutaneous flap in head and neck reconstruction
1979
Objective: to evaluate the results of the use of the pectoralis major flap in the reconstruction of head and neck surgeries. Methods: we conducted a retrospective study with data bank analysis and review of medical records of patients with head and neck cancer operated at the
Flap Selection in Head and Neck Cancer Reconstruction
An International Journal Otorhinolaryngology Clinics
Advances in head and neck reconstruction techniques have improved the results in function and the aesthetic outcome. Several flaps with different composition are available for specific reconstruction to achieve optimum result. Sensate free tissue transfer, dental rehabilitation and epiphyseal transfer for pediatric mandible are also now possible to achieve better function. The specific choice of the flap according to the region of defect and important keypoints in harvesting and reconstruction strategy for head and neck cancer are based on our experience in the last two decades.
Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases
International Journal of Head and Neck Surgery, 2014
This case series highlights the advantages in the use of three regional flaps, submental flap, sternocleidomastoid flap and transverse cervical flap in maxillofacial primary defect reconstruction after ablative cancer surgery through presentation of three head and neck cancer patients in whom it was decided to do pedicled flaps rather than free flaps. Aim and objective This article is done in an attempt for encouraging for more introduction of these three flaps in head and neck reconstruction practice, and to encourage more studies be done to describe skin territory of cervical flap. Materials and methods Three patients presented to oral and maxillofacial department, diagnosed as having different kinds of cancer. All were managed according to the evidence-based guideline of head and neck cancer management, including the work up, diagnosis, TNM classification, surgical treatment, adjuvant treatment and follow-up. In all the three cases, regional flaps were used to close the primary d...
The indications and complications of pectoralis major myocutaneous flap reconstruction in head and neck surgery-our experience
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 1998
Most of the head and neck cancer patients in India present to the Otolaryngologist, Head and Neck surgeon in the advanced stages of their disease. Extensive resection followed by acceptable morphological & functional reconstruction is the goal for the surgeon. Use of the pectoralis major myocutaneous (PMMC) flap enables extensive ablative procedures to be carried out followed by immediate and reliable reconstruction. Thirty consecutive cases of biopsy proven squamous cell carcinoma of the head and neck region were studied. All underwent extensive resection of the tumour with pectoralis major myocutaneous flap reconstruction, with preor post-operative external irradiation. This study concentrates on the indications for and complications encountered with the use of the pectoralis major myocutaneous flap. Also included is an extensive review of the literature relating to the complications encountered with the use of this method of reconstruction.
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The Superiorly Based Platysma Flap for Oral Reconstruction in Conjunction With Neck Dissection: A Case Series
Journal of Oral and Maxillofacial Surgery, 2007
Purpose: The purpose of this study was to access the reliability and use of the superiorly based platysma flap for reconstruction of small and medium oral defects. Patients and Methods: This case series consists of 5 patients who were reconstructed with a superiorly based platysma flap for defects of the following oral region: buccal mucosa, floor of the mouth, and lateral gingiva. The flaps were monitored for complications, including skin loss and ischemia in the postoperative period. Results: Three patients (60%) had some skin sloughing in the recipient site. None of the patients had complications in the donor site. Conclusion: The superiorly based platysma flap can survive after the facial artery has been ligated, which is the normal procedure during neck dissection. If skin sloughing occurs, it is usually inconsequential for intraoral reconstruction because the underlying muscle remains viable and undergoes epithelialization.
Platysma myocutaneous flap: Use for intraoral reconstruction
Otolaryngology - Head and Neck Surgery, 1997
Twenty patients were treated for infraoral epidermoid carcinoma with a single-stage reconstructive technique using a myocutaneous flap based on the platysma muscle. This flap carries on its distal tip a portion of isolated cervical skin to be used for intraoral replacement of the resected tissue. The superior vascular pedicle, the submental branch of the facial artery, was used. The platysma skin flap will survive if the blood supply from at least one region is preserved. In addition, it may be beneficial to include the external jugular and/or the communicating veins in the flap. Only three minor complications were seen and healed spontaneously. The flap has proved to be highly reliable and has significant benefits over many other techniques commonly used for head and neck reconstruction.
Submental Versus Platysma Flap for the Reconstruction of Complex Facial Defects Following Resection of Head and Neck Tumors
Pakistan Journal of Medical Sciences, 2014
Objective: To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. Methods: A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the
Pedicled myocutaneous flaps in head and neck surgery
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2000
Regional Flap in Head and Neck Reconstruction- Part I: Philosophy, Submental and Supraclavicular Flaps
Dentistry, 2017
Background: Regional (pedicled) flaps for reconstruction of intra-oral defects are acquiring increasing recognition as a safe, reliable choice in selected cases after oral cancer ablation (extirpation). The lower technical demands and suitability for elderly/high-risk patients together with specific features that may resolve the seemingly intractable dilemmas with other approaches, are providing a valuable tool in this challenging area of surgery. Aim: The aim of this paper is to describe our experience with the regional (pedicled) (submental, supraclavicular) flaps with a focus on reliability, function, cosmesis, donor site morbidity and oncological safety. Methods and results: Reconstructive techniques using distal flaps are described in 12 patients. In 8, engraftment was complete, in 3 there was partial necrosis and in 1 case, complete rejection of the flap. Conclusion: Regional (pedicled) flaps are thin, and pliable with good cosmetic and functional results. They can be accomplished in a one-stage reconstruction with minimum morbidity of donor site.
Infrahyoid myocutaneous flap in head and neck reconstruction
Head & Neck, 1993
lnfrahyoid myocutaneous flap is one of the alternatives to be considered for the reconstruction of moderate defects following resection of the oral cavity, oropharynx, or hypopharynx cancers. The flap is based on the uni-or bilateral superior thyroid pedicle; its major limitations are due to small flap volume and arc of rotation. The authors reviewed a series of 15 consecutive patients with carcinomas of the oral cavity or pharynx who underwent radical surgical resections followed by immediate reconstruction using an infrahyoid myocutaneous flap. Four of five cases with prior irradiation presented complications. The incidence of flap necrosis in this series (47%) was higher than that reported by others (10%). We consider the presence of massive neck metastasis and prior irradiation contraindications to the use of this flap. 0
The infrahyoid myocutaneous flap for reconstruction after resection of head and neck cancer
Cancer, 1986
Objective: To review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection. Methods: Chart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017. Characteristics of the patients and postoperative complications were analyzed. Results: Of the 34 patients in the study, 10 (29.4%) developed partial flap loss and 1 (2.9%) developed total flap loss. All cases of partial flap loss resolved with conservative treatment. Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure (odds ratio: 5.0, 95% CI: 1.03e24.28). Conclusions: The infrahyoid myocutaneous flap is a fairly reliable reconstruction method. The flap should be performed with caution in cases with gross lymph node involvement.
Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap
Bengal Journal of Otolaryngology and Head Neck Surgery
Introduction High lateral and posteriorly based defects are challenging to reconstruct as mobilization of conventional pedicled flaps is difficult. This study was done to evaluate the usefulness of lower trapezius myocutaneous flap (LTMC) in selected cases as a reconstructive alternative to other pedicled flaps which have positional and technical disadvantages and/or in cases where free flap is not possible. Materials and Methods Ten cases of locally advanced (T3 and T4) high and laterally placed head and neck carcinoma (8 cases of SCC involving posterior scalp, ear lobule, skin anterior to tragus and 2 cases of locally advanced salivary gland malignancies involving parotid glands) irrespective of sex had been selected. Due to non-availability of plastic surgeon in the institute none of the patient could be subjected to free flap reconstruction. All the patients received post operative adjuvant radiotherapy and were followed up on a monthly basis for six months at least. Results ...
Our Experience with Pectoraus Major Myocutaneous Flap and Its Complications in Head and Neck Reconstruction
Marmara Medical Journal, 1999
Objective: To investigate the results and complications of pectoralis major myocutaneous flap (PMMF) reconstruction in our department. Methods: Twenty-three patients who underwent head and neck cancer resection and reconstruction with PMMF in our department between 1988 and February 1998 were reviewed retrospectively. Results were assessed according to complications and risk factors. Results: Flap-related complications developed in 9 patients (39%); these were intraoperative vascular injury, total/partial flap necrosis, fistula formation and flap/suture line dehiscence. Blood albumin level was the most important risk factor for the development of complications. The median length of hospitalization for patients developing complications was 59 days compared with 18 days for those who did not develop complications. Conclusion: Although variable new techniques for head and neck reconstruction are described, the PMMF still remains an excellent tool for single-stage reconstruction in the ...
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